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Laparoscopic appendicectomy is superior to open surgery for complicated appendicitis
Gaik S Quah1, Guy D Eslick1, Michael R Cox2,3
1The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, NSW, Australia.
Surgical Endoscopy
|March 15, 2019
Summary
Laparoscopic appendicectomy (LA) for complicated appendicitis shows similar rates of intra-abdominal abscesses compared to open appendicectomy (OA). However, LA significantly reduces overall morbidity, mortality, and hospital stay, making it the preferred surgical approach.
Area of Science:
- Surgical Innovation
- Gastrointestinal Surgery
- Evidence-Based Medicine
Background:
- Laparoscopic appendicectomy (LA) is standard for uncomplicated appendicitis.
- Its use in complicated appendicitis (gangrenous/perforated) is debated due to concerns about intra-abdominal abscesses (IAA).
- This study compares LA with open appendicectomy (OA) for complicated appendicitis outcomes.
Purpose of the Study:
- To compare the post-operative outcomes of laparoscopic appendicectomy (LA) versus open appendicectomy (OA) for complicated appendicitis.
- To evaluate the incidence of intra-abdominal abscesses (IAA) between LA and OA.
- To assess overall morbidity, mortality, and length of hospital stay.
Main Methods:
- Systematic literature search adhering to PRISMA guidelines.
- Inclusion of randomized controlled trials (RCTs) and case-control studies (CCS).
- Analysis of data from 3 RCTs and 30 CCS involving 6428 patients.
Main Results:
- No significant difference in IAA rates between LA (6.1%) and OA (4.6%).
- LA demonstrated significantly lower overall post-operative morbidity (15.5% vs. 22.7%), wound infection, respiratory complications, and mortality.
- LA resulted in a shorter hospital stay (6.4 days vs. 8.9 days) and earlier resumption of solid food.
Conclusions:
- Laparoscopic appendicectomy (LA) for complicated appendicitis yields comparable IAA rates to open appendicectomy (OA).
- LA offers significantly reduced morbidity, mortality, and shorter hospital stays.
- LA should be considered the preferred treatment for complicated appendicitis.
Keywords:
Appendiceal abscessComplicated appendicitisGangrenous appendicitisLaparoscopic appendicectomyOpen appendicectomyPerforated appendicitisMore Related Videos
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